Trends in selective abortions of girls in India: Analysis of nationally representative birth histories from 1990 to 2005 and census data from 1991 to 2011

Centre for Global Health Research, Li Ka Shing Knowledge Institute, St Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, ON, Canada.
The Lancet (Impact Factor: 45.22). 06/2011; 377(9781):1921-8. DOI: 10.1016/S0140-6736(11)60649-1
Source: PubMed


India's 2011 census revealed a growing imbalance between the numbers of girls and boys aged 0-6 years, which we postulate is due to increased prenatal sex determination with subsequent selective abortion of female fetuses. We aimed to establish the trends in sex ratio by birth order from 1990 to 2005 with three nationally representative surveys and to quantify the totals of selective abortions of girls with census cohort data.
We assessed sex ratios by birth order in 0·25 million births in three rounds of the nationally representative National Family Health Survey covering the period from 1990 to 2005. We estimated totals of selective abortion of girls by assessing the birth cohorts of children aged 0-6 years in the 1991, 2001, and 2011 censuses. Our main statistic was the conditional sex ratio of second-order births after a firstborn girl and we used 3-year rolling weighted averages to test for trends, with differences between trends compared by linear regression.
The conditional sex ratio for second-order births when the firstborn was a girl fell from 906 per 1000 boys (99% CI 798-1013) in 1990 to 836 (733-939) in 2005; an annual decline of 0·52% (p for trend=0·002). Declines were much greater in mothers with 10 or more years of education than in mothers with no education, and in wealthier households compared with poorer households. By contrast, we did not detect any significant declines in the sex ratio for second-order births if the firstborn was a boy, or for firstborns. Between the 2001 and 2011 censuses, more than twice the number of Indian districts (local administrative areas) showed declines in the child sex ratio as districts with no change or increases. After adjusting for excess mortality rates in girls, our estimates of number of selective abortions of girls rose from 0-2·0 million in the 1980s, to 1·2-4·1 million in the 1990s, and to 3·1-6·0 million in the 2000s. Each 1% decline in child sex ratio at ages 0-6 years implied 1·2-3·6 million more selective abortions of girls. Selective abortions of girls totalled about 4·2-12·1 million from 1980-2010, with a greater rate of increase in the 1990s than in the 2000s.
Selective abortion of girls, especially for pregnancies after a firstborn girl, has increased substantially in India. Most of India's population now live in states where selective abortion of girls is common.
US National Institutes of Health, Canadian Institute of Health Research, International Development Research Centre, and Li Ka Shing Knowledge Institute.

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    • "The procedure used is crude one but estimates arrived could be compared with others. 4 A recent international study, published in The Lancet, found that selective abortion of girls in India has been increasing, and may account for up to '12 million missing girls with the lower estimate of 4 million over the last three decades' (Jha et al. 2011). During the last three decades, India has witnessed an alarming increase in the missing girls. "
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    • "Although selective feticide concerns only 2–4% of pregnancies carrying a girl, the numbers are very large in absolute terms.32 Estimates of the number of girls missing as a result of selective feticide range from a quarter to half a million per year.8,25,32,33,34 Female feticide was considered as a more acceptable alternative to female infanticide, but it did not always replace female infanticide. "
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    • "Together with female infanticide, the skewed sex ratio is believed to be caused by sex selective abortions [7]. The share of girls is often found to be especially low among higher birth orders in families without male offspring [7], confirming a hypothesis that families do not take action to make sure their next child is a boy until they have already got some children, but no or few sons. "
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